As the physiotherapist for the Australian Olympic Games triathlon team, I see similar patterns of overuse injuries in both elite and amateur tri-athletes. If the national team is to perform at its peak on the big day in August, I need to aim to stop these injuries arising. The foundation of our injury prevention strategy is the pre-participation musculo-skeletal screening of every triathlete.
Callaghan and Jarvis (1996) suggested that squad screening was an important strategy for evaluating elite athletes when they were working with British cyclists. They showed that a structured system can help early diagnosis and treatment to deliver injury-free cyclists at the start of a competitive season (although there is no direct evidence to support their claim).
So what are the key factors in designing a screening programme? Hershman (1984) identified three:
There is an abundance of separate biomechanical analyses of the three disciplines (swimming, cycling and running), but nothing specifically examines triathlon biomechanics or attempts to discover and compare any discrepancies found with the individual sports. Many triathlon injury profiles have been published and are highlighted in the references list below.
It is best to carry out the screening process out of competition, during the off-season, where the training load has been reduced. Screenings also take place before all major competitions, to ensure all athletes are injury-free. Thus we conduct screenings during February 2004 after the Australian triathlon racing season is over and the Olympic team has been announced.
Initially, each of the selected athletes is interviewed and the athletes’ injury history is thoroughly recorded. The physical assessment tests relevant joint ranges of motion and muscle strengths and we assess any current ailments. Video analysis of the triathletes’ swimming, cycling and running biomechanics – regularly undertaken by the state institutes of sport and/or the individual coaches – also forms part of the screening.
The purpose of these tests is to detect any predisposing factors that may lead to injury. Some common examples are:
If any relevant factors are detected, the athlete will be prescribed an individually tailored programme of stretches and exercises to rectify the problem and reduce the risk of future injury.
The purpose and benefits of the screening are to:
The Australian triathlon team was screened in November 2003 prior to the World Championships in New Zealand. We found two main predisposing factors to injury: stiffness in the thoracic spine and tight hip flexors. This pattern is extremely common in triathletes.
Cycling training is one potential cause of thoracic stiffness in triathletes, because of the time spent in the time-trial position. If good spinal posture is not maintained on the bike, the thoracic spine can become excessively hunched when the triathlete becomes fatigued. If the cycling spinal posture is not corrected and the mid-spine is not regularly stretched, stiffness can develop; a drop in cycling performance may follow as a result of the athlete adopting a less efficient aero-dynamic position.
This stiffness can also lead to a multitude of injuries, especially to the shoulders (impingement) during swimming. Swimming performance can also be adversely affected by the resultant restriction to shoulder range of motion, undermining the streamlined hydrodynamic position and causing a potential reduction in stroke length.
Two exercises that were given to the Australian team members to reduce thoracic stiffness and prevent injury were to:
This was the other injury risk factor detected in most of the team members. Again, this common problem arises because of the length of time triathletes have to spend with the hip bent in the time-trial position while cycling. Low-back injuries, hamstring and hip flexor strains and most lower limb overuse injuries can be linked to tight hip flexors. Hip flexor and quadriceps stretching are essential to prevent this pattern from developing. The muscle groups should be stretched daily, before and after activity (especially after cycling). Stretches should be held for approximately 30 seconds without bouncing, performed gently and slowly to the point of tension but never pain.
The final aspect of the musculo-skeletal screening is to view the triathletes’ biomechanics on video. Efficient and well-aligned running and cycling biomechanics are vital to performing well and also to prevent most lower-limb injuries from developing. When running and cycling, our legs should move up and down like pistons within an engine. If they do not, injuries can ensue.
Most triathletes could benefit from this visual assessment of their actions, and it can be performed by any sports physiotherapist or qualified athletics or triathlon coach. It is the starting point from which to develop appropriate drills and strategies to improve technique and rectify any biomechanical flaws.
Vleck V et al: Injury and training characteristics of male elite, development squad, and club triathletes. Int J Sports Med 1998 Jan;19(1):38-42
Wilk B et al: The incidence of musculoskeletal injuries in an amateur triathlete racing club. J Orthop Sports Phys Ther 1995 Sep;22(3):108-12
Collins K et al: Overuse injuries in triathletes. A study of the 1986 Seafair Triathlon. Am J Sports Med 1989 Sep-Oct;17(5):675-80
Korkia PK et al: An epidemiological investigation of training and injury patterns in British triathletes. Br J Sports Med 1994 Sep;28(3):191-6